Jean-François Kobiané

Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998-2003)

BackgroundBurkina Fasos immunization program has benefited regularly from national and international support. However, national immunization coverage has been irregular, decreasing from 34.7% in 1993 to 29.3% in 1998, and then increasing to 43.9% in 2003. Undoubtedly, a variety of factors contributed to this pattern. This study aims to identify both individual and systemic factors associated with complete vaccination in 1998 and 2003 and relate them to variations in national and international policies and strategies on vaccination of rural Burkinabé children aged 12-23 months.MethodsData from the 1998 and 2003 Demographic and Health Surveys and the Ministry of Healths 1997 and 2002 Statistical Yearbooks, as well as individual interviews with central and regional decision-makers and with field workers in Burkinas healthcare system, were used to carry out a multilevel study that included 805 children in 1998 and 1,360 children in 2003, aged 12-23 months, spread over 44 and 48 rural health districts respectively.ResultsIn rural areas, complete vaccination coverage went from 25.9% in 1998 to 41.2% in 2003. District resources had no significant effect on coverage and the impact of education declined over time. The factors that continued to have the greatest impact on coverage rates were poverty, with its various dimensions, and the utilization of other healthcare services. However, these factors do not explain the persistent differences in complete vaccination between districts. In 2003, despite a trend toward district homogenization, differences between health districts still accounted for a 7.4% variance in complete vaccination.ConclusionComplete vaccination coverage of children is improving in a context of worsening poverty. Education no longer represents an advantage in relation to vaccination. Continuity from prenatal care to institutional delivery creates a loyalty to healthcare services and is the most significant and stable explanatory factor associated with complete vaccination of children. Healthcare service utilization is the result of a dynamic process of interaction between communities and the healthcare system; understanding this process is the key to understanding better the factors underlying the complete vaccination of children.

Fertility Decline and Child Schooling in Urban Settings of Burkina Faso

As evidenced in Western rich countries, Asia, and Latin America, lower fertility allows couples to invest more in each of their children’s schooling. This postulate is the key rationale of family planning policies in sub-Saharan Africa. Yet, most studies on Africa have found no correlation or even a positive relationship between the number of children in a family and their educational attainment. These mixed results are usually explained by African family solidarity and resource transfers that might reduce pressures on household resources occasioned by many births as well as methodological problems that have afflicted much research on the region. Our study aims to assess the impact of family size on children’s schooling in Ouagadougou (capital of Burkina Faso), using a better measure of household budget constraints and taking into account the simultaneity of fertility and schooling decisions. In contrast to most prior studies on sub-Saharan Africa, we find a net negative effect of sibship size on the level of schooling achieved by children—one that grows stronger as they progress through the educational system.

Countries with Fertility Transitions in Progress

The aim of this chapter is to analyze the environmental and socio-economic factors influencing fertility in five sub-Saharan African countries where fertility transition has begun in recent years (Benin, Ghana, Gabon, Kenya, and Rwanda). The analysis is based mainly on the description of the socio-economic context and the data of the Demographic and Health Surveys (DHS) in these countries. Overall, it appears that the current level of fertility remains relatively high in the five countries, the TFR ranging from 4.0 in Ghana (2008) to 4.9 in Benin (2011–2012). However, a comparison of the most recent DHS with the oldest DHS shows: (1) a decline in early and latefertility; (2) a delay in the age at first marriage; (3) an increase in modern contraceptive use; (4) a sharp decline in infertility; and (5) a substantial improvement in the level of education in women of childbearing age. The pace of progress of these indicators varied from country to country, which could be attributed to the differential in the socio-economic context of the countries studied. The decline in fertility and future changes in the age structure which would be favorable to harnessing a demographic dividend will take several decades, unless strong social policies in the education and health sectors are implemented.

Fertility Limitation and Child Schooling in Ouagadougou: Selective Fertility or Resource Dilution?

Using original data collected in Ouagadougou, Burkina Faso, this study investigates evidence for the competing theories that fertility reductions increase childrens education through either the quantity-quality tradeoff (intentionally choosing smaller families to make greater investments in education and other indicators of child quality) or resource dilution (having more children reduces resources available per child, regardless of intentionality of family size). The results provide evidence for both hypotheses: children having four or fewer siblings were significantly more likely to be enrolled in school if their mothers had intentionally stopped childbearing relative to those whose mothers wanted more children but whose childbearing was limited by subfecundity. The difference between intentional and unintentional family limitation was not significant for parities greater than five. In addition, the relationship between number of siblings and their schooling is negative, regardless of the intentionality of family-size limitation, but the strength of this negative relationship is approximately twice as high among children whose mothers intentionally limited fertility (reflecting both selection and dilution effects) than among children whose mothers were subfecund (reflecting the pure dilution effect).